Antimicrobial resistance: Strengthening surveillance for public health action
Authors: Silvia Bertagnolio, Amitabh Bipin Suthar, Olga Tosas, Kitty Van Weezenbeek
Journal: PLoS Medicine (2023)

Antimicrobial resistance (AMR) is among the top ten global public health threats, demanding immediate attention and action [1].To effectively tackle AMR, it is crucial to have a comprehensive understanding of the extent of the problem.Specifically, reliable, accurate, and representative information on the incidence of resistant infections is vital for monitoring the national and global scale of AMR, identifying emerging threats, and evaluating the impact of interventions.As part of PLoS Medicine's Special Issue dedicated to AMR, Balasubramanian and colleagues shed light on the global magnitude of hospital-associated infections due to hospital acquired resistant infections (HARI) [2].One of the strengths of the study is the combination of data from hospital-based point prevalence surveys (PPS) with estimates of hospitalization rates, resistance prevalence, and country population size to predict the number of HARIs globally, across country income categories, and within nations.Using this approach, the authors estimated approximately 136 million HARI annually worldwide between 2010-2020.To our knowledge, these are among the first global incidence estimates of HARI.However, as acknowledged by the authors, results heavily rely on the availability of PPS data, which is limited in some regions and countries.According to the authors, only 11 low-and middle-income countries report this information, often based on small sample sizes, which may introduce bias and limit the generalizability of their findings.Additionally, the study relies on extrapolating country-level infection rates and resistance prevalence from available but scarce data at the hospital level, thus introducing uncertainties and assumptions that could impact the accuracy of the results.The heterogeneity of data from various sources and countries, with differences in data collection methods, diagnostic criteria, and reporting practices, could also affect the reliability of the estimates.Furthermore, due to the lack of available data, the study reports infections in an aggregated manner, without distinguishing specific infectious syndromes, which hampers the identification of more targeted syndrome-based interventions.Recent AMR burden estimates indicate that in 2019, 1.27 million deaths were attributed to drug resistant bacterial infections [3].Comparing estimates from different sources is limited by a lack of standardized reporting.Balasubramanian et al. included six bacteria and 13 antibiotic classes, across all infectious syndromes.[2].WHO's Global Antimicrobial Resistance and Use Surveillance System (GLASS) currently recommends 11 antibiotic classes, eight bacteria (Acinetobacter spp., E. coli, K. pneumoniae, Salmonella spp., S. aureus, Streptococcus pneumoniae, Shigella spp., and N. gonorrhoeae) and blood, urine, feces, and urethral and cervical swabs as priority specimen types for routine AMR surveillance and reporting to WHO [4].These criteria will be expanded and updated in the forthcoming WHO GLASS 2.0 manual.